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Study of Dupilumab to Demonstrate Efficacy in Subjects With Nummular Eczema (DUPINUM)

Primary Purpose

Nummular Eczema

Status
Recruiting
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Experimental: Dupilumab 300 MG/2 ML Subcutaneous Solution [DUPIXENT]
Sponsored by
Technical University of Munich
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Nummular Eczema focused on measuring Nummular Eczema, Dermatitis, Skin Diseases, Dupilumab, Anti-Inflammatory-Sgents

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Clinically confirmed diagnosis of NE.
  2. Biopsy-proven, meaning histology consistent with eczema (including PAS-staining).
  3. EASI score ≥ 10.
  4. PGA ≥ 3 on a 5 point scale.
  5. Female patients with reproductive potential must have a negative urine or serum pregnancy test within 7 days prior to start of trial.
  6. Female participants who are not capable of bearing children or who use a method of contraception that is medically approved by the health authority of the respective country at screening. Effective contraception (CTFG guideline) for women of childbearing potential should be used throughout the study, including during the follow-up period or at least 120 days after last dose, whichever is longer (elapse of 4-5 half-lives). The event of pregnancy, Dupilumab should be immediately discontinued.
  7. History of continuous use of at least mid-potency topical steroids for the last 8 weeks.
  8. Age 18-85 years of age, body weight ≥ 40 kg and ≤ 160 kg.
  9. Signed informed consent from patient.

Exclusion Criteria:

  1. Permanent severe diseases, especially those affecting the immune system.
  2. Pregnancy or breast feeding.
  3. Active chronic or acute infection requiring systemic treatment within 2 weeks before the baseline visit, independent from of the cuntaneous dysbiosis found in NE.
  4. Treatment with an investigational drug within 8 weeks before the baseline visit.
  5. Treatment with a live (attenuated) vaccine within 12 weeks before the baseline visit.
  6. Diagnosed active endoparasitic infections or at high risk of these infections.
  7. Evidence of severe renal dysfunction 8.Evidence of significant hepatic disease 9.Patients who are considered potentially unreliable or where it is envisaged the patient may not consistently attend scheduled study visits. 10.Inability or unwillingness to undergo repeated venipuncture (e.g., because of poor tolerability or lack of access to veins).

11.Inability or unwillingness to undergo repeated punch biopsies. 12.History of allergy to any component of the study medication. 13.Evidence of acute contact dermatitis at screening. 14.Evidence of Zink deficiency defined as Zink level < 20 µg/dL in serum. 15.History of important side effects of medium potency topical corticosteroids (eg, intolerance to treatment, hypersensitivity reactions*, significant skin atrophy, systemic effects), as assessed by the investigator or patient's treating physician.

16. ≥30% of the total lesional surface located on areas of thin skin that cannot be safely treated with medium potency TCS (eg, face, neck, intertriginous areas, genital areas, areas of skin atrophy) at baseline.

17. Planned or anticipated use of any prohibited medications and procedures during study treatment.

18. Known history of human immunodeficiency virus (HIV) infection. 19. Established diagnosis of Hepatitis B viral infection at the time of screening.

20. Established diagnosis of hepatitis C viral infection at the time of screening.

21. History of past or current tuberculosis or other mycobacterial infection. 22. Presence of skin comorbidities that may interfere with study assessments. 23. History of malignancy at any time before the baseline visit.

24. Severe concomitant illness(es) 25. Any other medical or psychological condition including relevant laboratory abnormalities at Screening 26. Planned major surgical procedure during the patient's participation in this study.

Sites / Locations

  • Klinikum re. Isar DermatologyRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Dupilumab

Placebo

Arm Description

Patients randomized to this arm will receive two subcutaneous injections of Dupilumab 300 mg (for a total of 600 mg) as a loading dose on Day 1, followed by single 300 mg injection of Dupilumab every 2 weeks (q2w) from week 2 to week 16.

Patients randomized to this arm will receive identically matching doses of placebo. Two subcutaneous injections of placebo as a loading dose (to mimic the experimental Dupilumab arm) on Day 1 followed by a single injection q2w from Week 2 to Week 16.

Outcomes

Primary Outcome Measures

EASI
The primary endpoint is the percent change in Eczema Area and Severity Index (EASI) score.

Secondary Outcome Measures

PGA
Number of Patients Achieving an Improvement (Decrease) in Physician Global Assessment (PGA) by two or more points
PGA
Number of Patients achieving an absolute PGA of 0 or 1
EASI
The proportion of subjects who achieve at least a 50% reduction in the EASI score
TEWL
Restoration of epidermal barrier function assessed by TEWL (Transepidermal Waterloss) will be measured using AquaFlux BIOX.
histological improvement
Assessed by reduction of epidermal thickness > 30% or reduction of inflammatory infiltrate > 50 %
Reduction of the Use of Topical Steroids
Prior to randomization and during the treatment, average application rate of class II topical steroids (standard medication "prednicarbate") per day will be calculated
DLQI
Change from Baseline in the Dermatology Life Quality Index (DLQI)
VAS
Pruritus Visual Analog Scale
TSQM
Global Satisfaction Subscale of the Treatment Satisfaction Questionnaire for Medication
Adverse Events
Type, incidence, severity, and relationship of the AEs to study medication

Full Information

First Posted
October 19, 2020
Last Updated
August 30, 2023
Sponsor
Technical University of Munich
Collaborators
University Hospital Munich
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1. Study Identification

Unique Protocol Identification Number
NCT04600362
Brief Title
Study of Dupilumab to Demonstrate Efficacy in Subjects With Nummular Eczema
Acronym
DUPINUM
Official Title
An Investigator-initiated, Multi-center, Randomized, Double-blind, Placebo Controlled Study of Dupilumab to Demonstrate Efficacy in Subjects With Nummular Eczema
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Recruiting
Study Start Date
March 30, 2021 (Actual)
Primary Completion Date
January 31, 2025 (Anticipated)
Study Completion Date
January 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Technical University of Munich
Collaborators
University Hospital Munich

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Nummular eczema (NE) is an idiopathic chronic inflammatory skin disease that occurs throughout all life periods. Diagnosis is made primarily clinically in correlation with histological findings. Treatment of NE is difficult. Standard treatment consists of the use of emollients, topical as well as systemic corticosteroids and phototherapy. Nevertheless, remission is hard to achieve and relapse occurs often. Patients usually suffer from severe pruritus and reduced quality of life. Therefore, new therapeutic strategies are urgently needed. Dupilumab (Dupixent®), a monoclonal antibody inhibiting the IL-4 and IL-13 pathway by targeting the IL-4-receptor, has been approved for the treatment of moderate-to-severe atopic dermatitis (AD). Since there is an overlap between AD and NE with both being caused by impaired epidermal barrier, broad immune-mediated inflammation and microbial skin colonization, using Dupilumab in NE seems to be promising.
Detailed Description
This study aims on investigating the efficacy of Dupilumab in NE patients. The primary endpoint is the percent change in Eczema Area and Severity Index (EASI) score from baseline to week 16. Secondary endpoints include the number of patients achieving an improvement (decrease) in Physician Global Assessment (PGA) by two or more points at week 16 as compared to week 0 or achieving an absolute PGA of 0 or 1 at Week 16, the EASI 50 score at week 16, the change from baseline in transepidermal waterloss (TEWL) at week 16, significant histological improvement at week 16, change from baseline in the reduction of the use of topical steroids at week 16, change form baseline in the Dermatology Life Quality Index (DLQI) at week 16, change from baseline in Pruritus Visual Analog Scale (VAS), change from baseline in the global satisfaction subscale of the treatment satisfaction questionnaire for medication (TSQM) score at week 16 and the safety of Dupilumab.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Nummular Eczema
Keywords
Nummular Eczema, Dermatitis, Skin Diseases, Dupilumab, Anti-Inflammatory-Sgents

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
This is an investigator-initiated, multi-center, prospective, randomized, double-blind, interventional phase II study.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
double-blind
Allocation
Randomized
Enrollment
70 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dupilumab
Arm Type
Experimental
Arm Description
Patients randomized to this arm will receive two subcutaneous injections of Dupilumab 300 mg (for a total of 600 mg) as a loading dose on Day 1, followed by single 300 mg injection of Dupilumab every 2 weeks (q2w) from week 2 to week 16.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients randomized to this arm will receive identically matching doses of placebo. Two subcutaneous injections of placebo as a loading dose (to mimic the experimental Dupilumab arm) on Day 1 followed by a single injection q2w from Week 2 to Week 16.
Intervention Type
Drug
Intervention Name(s)
Experimental: Dupilumab 300 MG/2 ML Subcutaneous Solution [DUPIXENT]
Intervention Description
Subcutaneous
Primary Outcome Measure Information:
Title
EASI
Description
The primary endpoint is the percent change in Eczema Area and Severity Index (EASI) score.
Time Frame
From baseline to week 16.
Secondary Outcome Measure Information:
Title
PGA
Description
Number of Patients Achieving an Improvement (Decrease) in Physician Global Assessment (PGA) by two or more points
Time Frame
at week 16 as compared to week 0
Title
PGA
Description
Number of Patients achieving an absolute PGA of 0 or 1
Time Frame
at Week 16.
Title
EASI
Description
The proportion of subjects who achieve at least a 50% reduction in the EASI score
Time Frame
From baseline to week 16
Title
TEWL
Description
Restoration of epidermal barrier function assessed by TEWL (Transepidermal Waterloss) will be measured using AquaFlux BIOX.
Time Frame
From baseline to week 16
Title
histological improvement
Description
Assessed by reduction of epidermal thickness > 30% or reduction of inflammatory infiltrate > 50 %
Time Frame
From baseline to week 16
Title
Reduction of the Use of Topical Steroids
Description
Prior to randomization and during the treatment, average application rate of class II topical steroids (standard medication "prednicarbate") per day will be calculated
Time Frame
From baseline to week 16
Title
DLQI
Description
Change from Baseline in the Dermatology Life Quality Index (DLQI)
Time Frame
Total Score at Week 16
Title
VAS
Description
Pruritus Visual Analog Scale
Time Frame
Total Score at Week 16
Title
TSQM
Description
Global Satisfaction Subscale of the Treatment Satisfaction Questionnaire for Medication
Time Frame
Total Score at Week 16
Title
Adverse Events
Description
Type, incidence, severity, and relationship of the AEs to study medication
Time Frame
From baseline to week 16

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinically confirmed diagnosis of NE. Biopsy-proven, meaning histology consistent with eczema (including PAS-staining). EASI score ≥ 10. PGA ≥ 3 on a 5 point scale. Female patients with reproductive potential must have a negative urine or serum pregnancy test within 7 days prior to start of trial. Female participants who are not capable of bearing children or who use a method of contraception that is medically approved by the health authority of the respective country at screening. Effective contraception (CTFG guideline) for women of childbearing potential should be used throughout the study, including during the follow-up period or at least 120 days after last dose, whichever is longer (elapse of 4-5 half-lives). The event of pregnancy, Dupilumab should be immediately discontinued. History of continuous use of at least mid-potency topical steroids for the last 8 weeks. Age 18-85 years of age, body weight ≥ 40 kg and ≤ 160 kg. Signed informed consent from patient. Exclusion Criteria: Permanent severe diseases, especially those affecting the immune system. Pregnancy or breast feeding. Active chronic or acute infection requiring systemic treatment within 2 weeks before the baseline visit, independent from of the cuntaneous dysbiosis found in NE. Treatment with an investigational drug within 8 weeks before the baseline visit. Treatment with a live (attenuated) vaccine within 12 weeks before the baseline visit. Diagnosed active endoparasitic infections or at high risk of these infections. Evidence of severe renal dysfunction 8.Evidence of significant hepatic disease 9.Patients who are considered potentially unreliable or where it is envisaged the patient may not consistently attend scheduled study visits. 10.Inability or unwillingness to undergo repeated venipuncture (e.g., because of poor tolerability or lack of access to veins). 11.Inability or unwillingness to undergo repeated punch biopsies. 12.History of allergy to any component of the study medication. 13.Evidence of acute contact dermatitis at screening. 14.Evidence of Zink deficiency defined as Zink level < 20 µg/dL in serum. 15.History of important side effects of medium potency topical corticosteroids (eg, intolerance to treatment, hypersensitivity reactions*, significant skin atrophy, systemic effects), as assessed by the investigator or patient's treating physician. 16. ≥30% of the total lesional surface located on areas of thin skin that cannot be safely treated with medium potency TCS (eg, face, neck, intertriginous areas, genital areas, areas of skin atrophy) at baseline. 17. Planned or anticipated use of any prohibited medications and procedures during study treatment. 18. Known history of human immunodeficiency virus (HIV) infection. 19. Established diagnosis of Hepatitis B viral infection at the time of screening. 20. Established diagnosis of hepatitis C viral infection at the time of screening. 21. History of past or current tuberculosis or other mycobacterial infection. 22. Presence of skin comorbidities that may interfere with study assessments. 23. History of malignancy at any time before the baseline visit. 24. Severe concomitant illness(es) 25. Any other medical or psychological condition including relevant laboratory abnormalities at Screening 26. Planned major surgical procedure during the patient's participation in this study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Alexander Böhner, Dr. med.
Phone
+49 (0) 89 4140
Ext
3195
Email
alexander.boehner@tum.de
First Name & Middle Initial & Last Name or Official Title & Degree
Beate Schossow, PM
Phone
+49 (0) 89 4140
Ext
6469
Email
beate.schossow@mri.tum.de
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thilo Biedermann, Prof.Dr.med.
Organizational Affiliation
Klinikum re. Isar, Technische Universität München, Dermatologie
Official's Role
Principal Investigator
Facility Information:
Facility Name
Klinikum re. Isar Dermatology
City
München
State/Province
Bayern
ZIP/Postal Code
81675
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tilo Biedermann, Prof. Dr. med
Phone
+49 (0)89 41 40 -
Ext
3170
Email
tilo.biedermann@tum.de
First Name & Middle Initial & Last Name & Degree
Alexander Böhner, Dr. med.
Phone
+49 (0)89 41 40 -
Ext
3060
Email
alexander.boehner@mri.tum.de

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
All participant data collected during the clinical trial (pseudonymized)
IPD Sharing Time Frame
A year later according to LPLV
IPD Sharing Access Criteria
Publikation

Learn more about this trial

Study of Dupilumab to Demonstrate Efficacy in Subjects With Nummular Eczema

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